Resource impact summary report
Resource impact summary report
This summary report is based on the NICE assumptions used in the resource impact template. Users can amend the 'Inputs and eligible population' and 'Unit costs' worksheets in the template to reflect local data and assumptions.
Recommendations
Lorlatinib can be used as an option for ALK-positive advanced non-small-cell lung cancer (NSCLC) in adults who have not had an ALK inhibitor. Lorlatinib can only be used if the company provides it according to the commercial arrangement.
This recommendation is not intended to affect treatment with lorlatinib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.
Eligible population for lorlatinib
Table 1 shows the population who are eligible for lorlatinib and the number of people who are expected to have lorlatinib in each of the next 5 years, including forecast population growth.
| Eligible population and uptake | People eligible for lorlatinib | Uptake for lorlatinib (%) | People starting treatment each year |
|---|---|---|---|
|
Current practice without lorlatinib |
281 |
0 |
0 |
|
Year 1 |
283 |
20 |
57 |
|
Year 2 |
286 |
35 |
100 |
|
Year 3 |
288 |
50 |
144 |
|
Year 4 |
291 |
50 |
145 |
|
Year 5 |
293 |
50 |
147 |
The following assumptions have been used to calculate the eligible population:
-
70% of NSCLC cases are of non-squamous histology
-
66% of NSCLCs are diagnosed at an advanced stage (stage 3 or greater)
-
people with an Eastern Cooperative Oncology Group (ECOG) status of 0 to 2 would in clinical practice have treatment; this is estimated to be 75% of people diagnosed with advanced NSCLC
-
4.5% of the above will be anaplastic lymphoma kinase (ALK) positive
-
49% will have systematic anti-cancer therapy.
The market share for lorlatinib is based on clinical expert opinion.
Treatment options for the eligible population
The comparator treatments for the eligible population are alectinib or brigatinib. Lorlatinib is already used after alectinib or brigatinib. Lorlatinib, alectinib and brigatinib are all oral treatments.
For more information about the treatments, such as dose and average treatment duration, see the resource impact template.
Financial resource impact (cash items)
The company has a commercial arrangement. This makes lorlatinib available to the NHS with a discount.
Users can input the confidential price of lorlatinib and amend other variables in the resource impact template.
The mean treatment durations at first line for lorlatinib, alectinib and brigatinib are all commercial in confidence, so the median treatment durations have been used in the template. These can be adjusted locally.
The payment mechanism for the technology is determined by the responsible commissioner and depends on the technology being classified as high cost.
For further analysis or to calculate the financial impact of cash items, see the resource impact template.
Capacity impact
There is not expected to be a difference in monitoring requirements between lorlatinib, alectinib or brigatinib while on treatment. If people have lorlatinib as first-line treatment then they would not be eligible to have second-line treatment with lorlatinib, which may constitute a saving in the treatment pathway.
Lorlatinib has a different toxicity profile to those of alectinib and brigatinib and has greater potential for causing central nervous system-related adverse effects. Healthcare professionals in the NHS have experience of managing adverse effects when using lorlatinib at second line. So, although adverse effects can substantially affect quality of life, they are often manageable with supportive care or by dose reductions.
For further analysis or to calculate the financial capacity impact from a commissioner (national) and provider (local) perspective, see the resource impact template.
Key information
| Time from publication to routine commissioning funding |
90 days |
|---|---|
| Programme budgeting category |
2D Cancers & Tumours – Lung |
| Commissioner(s) |
NHS England |
| Provider(s) |
NHS hospital trusts |
| Pathway position |
First-line treatment for ALK-positive advanced non-small-cell lung cancer that has not been previously treated with an ALK inhibitor |
About this resource impact summary report
This resource impact summary report accompanies the NICE technology appraisal guidance on lorlatinib for ALK-positive advanced non-small-cell lung cancer that has not been treated with an ALK inhibitor and should be read with it.
ISBN: 978-1-4731-7282-1
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